Disordered Eating in Entry-Level Military Personnel

Military Medicine, Feb 2007 by Warner, Christopher, Warner, Carolynn, Matuszak, Theresa, Rachal, James, Et al

Objective: The goal was to determine the prevalence of and risk factors for disordered eating in an entry-level U.S. Army population. Methods: A cross-sectional survey of advanced individual training U.S. Army soldiers at Aberdeen Proving Ground, Maryland, was performed with an anonymous self-report survey containing demographic factors, history (including abuse and psychiatric treatment), and Eating Attitudes Test-26. Results: Of 1,184 advanced individual training soldiers approached, 1,090 participated. The response rate was 91.2% (955 men and 135 women). Forty percent were overweight (body mass index of ≥25), 11% reported a psychiatric history, 26% reported a history of abuse, and 9.8% endorsed disordered eating (male, 7.0%; female, 29.6%), as defined by Eating Attitudes Test-26. Factors that placed soldiers at higher risk for disordered eating were female gender (odds ratio, 5.63; 95% confidence interval, 3.32-9.57; p

Introduction

Eating disorders and disordered eating behaviors have increasingly been a subject of research and awareness, particularly in young adult populations such as college students and young athletes. Eating disorders occur most commonly in adolescents and young adults and are 10 times more common among female individuals than male individuals.1,2 Eating disorders occur in all ethnic groups but traditionally are viewed as being most common among Caucasian individuals in industrialized nations.3 The principal eating disorders are anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.4 For young women, the lifetime risk of developing anorexia is 0.5 to 1%, and the mortality rate is estimated at 4 to 10%.5,6 In addition, the risk of developing bulimia is 2 to 5%, and the incidence of disordered eating that does not meet strict criteria for eating disorders may be twice that of the aforementioned conditions (4-10%).7-9

Recurrent dieting and desire for weight loss occur much more commonly than overt eating disorders. In 1999, the Youth Risk Behavior Surveillance Survey reported that 58% of high school students in the United States had exercised to lose weight and 40% had restricted caloric intake in an attempt to lose weight.10 Although for some this may reflect attempts at a healthier lifestyle, for others it may be evidence of disordered eating patterns and potential development of clinically significant eating disorders.

Entry-level, active duty, military personnel are primarily in the age range at highest risk for eating disorders, but this is a population that has not been extensively studied to assess the prevalence of these disorders. A 1999 study found that 33.6% of 423 military women screened positive for disordered eating and 8% were diagnosed as having an eating disorder through a diagnostic interview.11 Other studies examining the military population reported varying prevalence for anorexia nervosa (0.2-4.9%), bulimia nervosa (0.7-15.9%), and eating disorder not otherwise specified (6.9-76.7%).11-13 The wide range of findings may be attributable to differences in the sample populations or the criteria used to establish the presence of a disorder. Another study noted a 20% rate of disordered eating attitudes in female Reserve Officer Training Corps cadets.14 Only one study looked at rates in male subjects, noting rates of 2.5% for anorexia nervosa, 6.8% for bulimia nervosa, and 40.8% for eating disorder not otherwise specified.15 The majority of those studies used the Eating Disorder Inventory or a modified form of that instrument and did not include a diagnostic interview in the assessment of subjects. In addition, those studies all included military officers, subjects who have a higher socioeconomic status. No studies looked exclusively at enlisted soldiers in training.

Results (unpublished data) from the Aberdeen Proving Ground Women's Health Initiative were reported at the 2003 U.S. Army Force Health Protection Conference. In that presentation, the investigators noted that almost one-third (31.3%) of women in entry-level training had probable disordered eating attitudes and behaviors. However, that study (unpublished data) used a nonvalidated screening tool. This rate was unexpected for a population that tends to be of lower socioeconomic status and lower education levels, factors that lower risk for disordered eating.

Multiple studies have reported an increased risk for eating disorders in patients with a history of abuse.16"19 Previous studies of sexual abuse in the general population showed a prevalence ranging from 10 to 34% for female individuals and up to 5% for male individuals.20-22 There are no data on the lifetime prevalence of childhood physical abuse, but the most recent report by the U.S. Department of Health and Human Services reported that, among all cases of child maltreatment in 2002, 18.6% involved physical abuse, with nearly equal distributions in male and female individuals.23 Previous military studies reported a rate of 35% for sexual abuse and 57% for physical abuse in female Navy recruits.24 No previous studies have examined the relationship of abuse before enlistment and disordered eating among entry-level personnel.